The nighttime environment and incontinence care practices in nursing homes.
OBJECTIVE
To determine the variability in noise, light, and incontinence care practices between nursing homes (NHs) and the association between these factors and residents' nighttime sleep.


METHODS
Prospective descriptive study of a sample of incontinent NH residents.


METHODS
Ten nursing homes.


METHODS
Two hundred twenty-five incontinent NH residents.


METHODS
Measurements of residents' sleep by wrist actigraphs, bed mobility by pressure sensitive Kynar strips, and environmental noise and light changes were recorded by bedside monitors in consecutive 2-minute intervals for two 10-hour nighttime data collection periods (7 PM to 5 AM).


RESULTS
Forty-two percent of waking episodes lasting 4 minutes or longer were associated with noise, light, or incontinence care events. Twenty-two percent of waking episodes of 4 minutes or longer were associated with noise alone, 10% with light or light + noise, and 10% with incontinence care routines. Seventy-six percent of all incontinence care practices resulted in awakenings. There was variability between the 10 NHs, with the percentage of waking episodes associated with environmental events (noise, light, or incontinence care events) ranging from 23.6 to 66.0%.


CONCLUSIONS
Noise and incidents of incontinence care practices were associated with a substantial amount of sleep disruption in residents in all 10 nursing homes, even though there was variability between homes. Interventions minimizing such environmental events are needed to promote better sleep in incontinent NH residents.
Cruise
P A
PA
Borun Center for Gerontological Research and UCLA School of Medicine, California, USA.
Schnelle
J F
JF
Alessi
C A
CA
Simmons
S F
SF
Ouslander
J G
JG
D000368:Aged; D016330:Frail Elderly; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008027:Light / Q000009:adverse effects; D009622:Noise / Q000009:adverse effects*; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D005791:Patient Care / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D012893:Sleep Wake Disorders / Q000209:etiology*; D014549:Urinary Incontinence / Q000628:therapy*